Mycoplasma Genitalium guide: Screening and diagnostic testing
Screening and diagnostic testing for Mycoplasma genitalium.
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Screening for M. genitalium
Routine screening for M. genitalium is not recommended.
Testing for M. genitalium is recommended only when chlamydia and gonorrhea have been ruled out as a cause of persistent or recurrent urethritis, cervicitis or pelvic inflammatory disease (PID) following empiric treatment for gonorrhea and chlamydia, when pre-treatment NAAT tests or follow-up TOC are negative for chlamydia and gonorrhea).
There is no data to guide recommendations for screening or testing in pregnant people and neonates.
Screening for other sexually transmitted and blood-borne infections (STBBIs)
STBBI screening varies by age, gender, sex, and medical and sexual history. Screen anyone who presents with STBBI risk factors and treat as appropriate to prevent transmission and reinfection.
People being evaluated or treated for a M. genitalium infection should be screened for:
- Syphilis
- Human immunodeficiency virus (HIV), as per the recommendations in the HIV Screening and Testing Guide
Infection with M. genitalium may increase the risk of acquisition and transmission of HIVFootnote 1.
Diagnostic testing
Clinical presentation and sexual history determine which specimens should be collected.
Laboratory testing capacity with NAAT for M. genitalium varies across Canada. Check with your laboratory about the availability of M. genitalium testing, specimen collection and transportation requirements.
Where nucleic acid amplification tests (NAAT) for M. genitalium are available, acceptable specimens are Footnote 2, Footnote 3:
- First-void urine (FVU), first 10-20 mL
- Cervical, vaginal, urethral or meatal swabs
- Endometrial biopsies
M. genitalium-positive specimens can be forwarded to the National Microbiology Laboratory (NML) for molecular detection of mutations associated with macrolide and moxifloxacin resistance Footnote 4, Footnote 5. Refer to the NML Guide to Services for specific information on specimen collection and transportation requirements.
References
- Footnote 1
Vandepitte J, Weiss HA, Bukenya J, et al. Association between mycoplasma genitalium infection and HIV acquisition among female sex workers in uganda: Evidence from a nested case-control study. Sex Transm Infect. 2014;90(7):545-549. doi: 10.1136/sextrans-2013-051467 [doi].
- Footnote 2
Chernesky M, Jang D, Smieja M, et al. Urinary meatal swabbing detects more men infected with mycoplasma genitalium and four other sexually transmitted infections than first catch urine. Sex Transm Dis. 2017;44(8):489-491. doi: 10.1097/OLQ.0000000000000618 [doi].
- Footnote 3
Dize L, Agreda P, Quinn N, Barnes MR, Hsieh YH, Gaydos CA. Comparison of self-obtained penile-meatal swabs to urine for the detection of C. trachomatis, N. gonorrhoeae and T. vaginalis. Sex Transm Infect. 2013;89(4):305-307. doi: 10.1136/sextrans-2012-050686 [doi].
- Footnote 4
Jensen JS. Protocol for the detection of mycoplasma genitalium by PCR from clinical specimens and subsequent detection of macrolide resistance-mediating mutations in region V of the 23S rRNA gene. In: Diagnosis of sexually transmitted diseases. Springer; 2012:129-139.
- Footnote 5
Shimada Y, Deguchi T, Nakane K, et al. Emergence of clinical strains of mycoplasma genitalium harbouring alterations in ParC associated with fluoroquinolone resistance. Int J Antimicrob Agents. 2010;36(3):255-258.